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Deactivated NPI 1164711586 Deactivated / Inactive NPI Male Practitioner

Dr. Walter Ray Petersen , MD

General Practice • Burley, ID

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Walter Petersen has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date April 06, 2011
NPI Deactivation Date October 07, 2020
Total Practice Duration ~9 Years of Practice (2011 – 2020)

Professional Overview & Biography Verified Profile Summary

Dr. Walter Petersen, MD was a registered General Practice practicing in Burley, ID. Throughout an active medical career spanning 9 years, Dr. Petersen provided care at the practice location at 1344 HILAND AVE until profile deactivation on 2020-10-07.

Practice Location & Contact Primary Location

Practice Address

1344 Hiland Ave

Burley, ID 833181564

Telephone 2086781138
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Burley, ID

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 23.6 Yrs
Regional Practice Density
1 Specialists

Practicing in Burley, ID (37 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License ID M2705

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
NPI 1225105604

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated October 07, 2020

Record deactivated on October 07, 2020

NPI Profile Active April 06, 2011

NPI status registered as active in NPPES database

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Updated Practice Location April 06, 2011

Registered at 1344 HILAND AVE, BURLEY, ID 833181564 (Tel: 2086781138)

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Updated Business Mailing Address April 06, 2011

Registered at 1344 HILAND AVE, BURLEY, ID 833181564 (Tel: 2086781138)

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Provider Name / Credentials Updated April 06, 2011

Recorded as WALTER PETERSEN, M.D.

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Medical Taxonomy / Specialty Registered (Primary Specialty) April 06, 2011

General Practice (License #M2705 in ID)

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Initial NPI Registration & Enumeration April 06, 2011

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1164711586
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: April 06, 2011
Last Update: April 06, 2011
Deactivation Date: October 07, 2020

Mailing Address

1344 Hiland Ave

Burley, ID 833181564

Phone: 2086781138

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.